Saturday, March 26, 2011

Duke Medical's Hypocrisy: Conference on Research Integrity

Something amazing will be happening at Duke University Medical on March 30, 2011.  Odd, manipulative, inappropriate given the last years of dishonesty on the part of Duke University Medical 

Third Annual HRPP Conference on Research Integrity
March 30, 2011
All clinical research staff including investigators and coordinators are invited to attend the conference on research integrity. Guest speakers will include Eva Kor, a Holocaust survivor on whom Dr. Mengele performed twin experiments. Debra Parrish, JD, is a popular presenter who will discuss the difference between protocol noncompliance and research misconduct.
A panel discussion is also planned and will include Sally Kornbluth, Rob Califf, Scott Gibson and Ross McKinney.

Really?  Research integrity?  

Duke Medical has become synonymous with "research and medical fraud."

The Anil Potti, M.D. cancer fraud scandal

Anil Potti, M.D. brought embarrassment and shame on cancer research at Duke  To add insult to potential Dr. Potti impacted cancer patients, Duke University has thus far refused to notify potential cancer patients that they may have been subjected to Dr. Potti's unprovable cancer research protocol.

To add further insult to potential Dr. Potti impacted cancer victims, Duke University actually hired a local newspaper reporter (News and Observer) who was beginning to expose Duke's cover-up. That seems, IMHO, to be Duke's way of silencing a reporter and, therefore, preventing information from getting to the public.  

Hydraulic Elevator Oil cleaning surgical equipment scandal

At the end of 2004, a major Duke University Hospital scandal was exposed.  And that scandal continues to this day.

Over the complaints of Duke Medical personnel who noticed equipment was "greasy, slimy, Duke Medical surgeons continued to use surgical instruments that were washed in hydraulic elevator oil.  

Instead of  throwing away all of the contaminated surgical equipment, Duke University attempted to re-clean the equipment.  But according to the very ethical Research Triangle Institute International ("RTI"), there was still unacceptable levels of heavy metals.  

Okay, now throw away the equipment Duke University.  Right?   Nope.  Duke University instead asked RTI to falsify the findings. RTI declined the suggestion.

At this point, no post 2004 Duke University Medical surgical patient can be certain whether he or she was victimized by Duke Medical's unsuccessful attempt to clean contaminated scalpel, clamps, etc.  That is horrifying and scary for patient, families, friends.

Duke University remains silent about what patients may have been exposed to contaminated equipment and/or fraudulent cancer researchers.  

Rationing medical care to elderly by Duke University Hospital hospitalists

On a personal note, Duke University Hospital rationed my dad's care (as documented by my dad prior to his January 2010 death).  Hospitalists refused to provide care even though dad had medical insurance.  The job of Hospitalists is to save hospitals money and reduce admissions.  

Hospitalists pride themselves on routing the elderly to nursing homes instead of the hospital.  I advocated for my dad that he be given medical care, not merely nursing care.  That made Duke Medical very angry at me.

Refusing medical care to patient advocates who question rationing of care

Nine months after my dad died, I was diagnosed in September 2010 with osteomyelitis (from contaminated metal placed in my tibia in December 2004), Duke orthopedic surgeon Michael Bolognesi, MD ignored my infection, discharged me with an open wound and bone infection.

Thereafter Dr. Michael Bolognesi (or someone at his direction) communicated with orthopedic surgeons at UNC-Chapel Hill and Cleveland Clinic Foundation to prevent me from obtaining care.  Six months later, I have dead tibia, systemic infection and open surgical wound to my dead tibia bone.

So precisely what is the purpose of Duke University's Conference on Research Integrity?  Are all the victims of Duke's unethical Hospitalist Program Model, cancer fraud and contaminated surgical equipment supposed to feel guilty and forgive Duke University Medical for its lies, cover-ups and rationing of care.  

I hope no victim patient of Duke University Medical feels a shred of guilt that they are angry at the poor medical treatment (cover-ups and deceit) subjected to at Duke University Medical.

Advocacy is essential in the medical care system.  You must be an advocate for yourself, your loved ones and every other American citizen.  You must be an advocate for the physician/patient relationship - not the corporate or government practice of medicine (aka Obama Care).

Friday, March 18, 2011

Caregiving for Deceased Human's Pets

My dad has been dead for 14 months.  I have learned a lot during the 14 months.

1.  Learned about estates;
2.  Learned about physicians CYAs;
3.  Learned about many of dad's physicians not wanting to treat once strong family advocates (me);
4.  Learned about the need for families to remain strong for the surviving spouse;
5.  Learned that government resources are not helpful; and
6.  Learned that the deceased human's pet will grieve.

My dad had an Irish Setter, Heather.  She was a beautiful dog inside and out.  Heather worried about dad when he was home sick.  She was depressed, refused food when he was hospitalized.

After dad died, Heather would go into his room, sit on his bed, look up into the corner of the room and actually carry on a conversation with something with a corner of the room!?   

This past weekend, Heather became very week and stopped being able to move her back legs.  She allowed me to spoon feed her baby food.  She drank water on her own.  I tried to get her to the vet and the NCSU Vet School on Monday.  But could not get her into Heather's primary vet until Wednesday morning.

As I was preparing to get ready to take Heather to her vet, my mom was holding Heather's head up so that she could drink water.  Heather died in mom's arms.  Fourteen months and one day early, my dad died in mom's arms.

I miss Heather will all my heart.  One part of my wishes that I could have made her happy here on Earth.  But, Heather was my dad's dog.  She loved my dad.  And dad wanted to be able to run with his Irish Setter.  Now that my dad is no longer in the pain from osteomyelitis in his legs, dad can run.  

They can run throughout Heaven

Dad and Heather can both run.  Keep them safe God.  Please keep them safe and don't let them forget about me.

Wednesday, March 16, 2011

Time to Get Serious about Health Care - Time to Consider Herman Cain

Consider Herman Cain as Presidential Material.  Why?
Because Herman Cain is the Voice of Reason on Health Care.

It seems that health care (and health care costs) have again taken a back seat to other important economic issues in America.  

For many people, it takes a personal or family medical condition to bring health care (and health care costs) into the forefront.   

For pharmaceutical companies, health care management companies, durable medical equipment companies, medical staffing companies, medical insurance companies, medical professionals, medical paraprofessionals, medical lobbyists, politicians, health insurance companies, health insurance company administrators, hospital and medical clinic administrators, imaging center professionals, imagining center administrators, attorneys, risk managers, all levels of governments ... whew ... health care (and health care costs) are always an issue. That sure is a lot of people between the patient and the physician.

As a conservative, I want control over my own life and I believe that people fare much better when they likewise maintain control over their own lives.  My grandfather (Clarence W. Fackler, Ph.D) taught economics at NYU in 1935.  When the Social Security of 1935 Act was passed, my grandpa was able to avoid participating in Social Security.  Grandpa Fackler was a man of principle.  He planned for his family and knew that at its inception Social Security was not good for the United States.

Grandpa Fackler passed away before Medicare.  He undoubtedly screamed down from Heaven when Congress made the significant addition (to the Social Security Act in 1935) and the law passed on July 30, 1965.  I am sure Grandpa Fackler also screamed from Heaven when Obama Care (also known as "The Patient Protection and Affordable Care Act" was passed.  I never met the man.  But I think I heard him scream from Heaven last year.

So, is the conversation about health care over?  Are we a country doomed to Obama Care and now heading towards universal health care/a single payer system/"Medical for all"?  Did summer of 2009 town hall meetings, rallies and discussions with congressmen mean nothing?  What? Not just no.  Hell no.

It is time to roll up our collective sleeves again and get serious about health care cost reform.  Yeah, you heard me.  We all know the problem with health care in America has never been about health care in America.  It has been about health care costs.  (My favorite example: an female left elbow 3 view x-ray should cost the same at hospital "A" regardless of whether the patient has insurance 1, insurance 2 or is a private pay.  But hospitals have contracts for different prices.  And, the private pay is charged a premium price because the hospital only has contracts with insurance companies for lower prices. Precisely how much sense does that make for the private pay patient?)  America has the best health care in the world.  Period.

Regardless of political ideology, patients and physicians want to maintain the relationship between themselves.  The exam room door shuts and attorneys, pharmaceutical companies, insurance companies, politicians, bureaucrats need to be out of the room. Far, far away from (and out of) the exam room.

So what alternative do we have at this point?  I mean, Obama won right?  We (that would mean the majority of the American people) lost and we are "stuck" with Obama Care, right?  Suck it up.  Elections have consequences.  Don't be a sore loser.  Oh for pity sakes, grow up.  Even our President picked winners and losers in his NCAA basketball brackets.  What?  Not just no.  Hell no. We cannot sit back and let Obama Care continue. 

Obama Care will destroy our economy, marginalize the medical profession, ruin the patient-physician relationship and lead to further rationed care.

The alternative my patriotic friends is to stop playing the game of "who does the mainstream media think polls best"?  

It is time to take a strong, serious look at a true patriot who will best represent true conservative base - Mr. Herman Cain.  He is a businessman, patriot, leader, fighter, winner. Mr. Cain has a proven track record of looking tough issues straight in the proverbial eyes, taking issues on with logical, methodical strategies and demonstrating extraordinary results.

Herman Cain supports a plan that has already been proposed by Republicans. (H.R. 3400 ) In fact, Herman Cain wrote a commentary about what he describes as "the GOP Alternative to Obama Care." 

Herman Cain explains Empowering Patients First Act (H.R. 3400) would allow:
  • Individuals to choose their health insurance (no mandates)
  • Deductibility of health insurance premiums regardless of who pays
  • Employers to provide flexible health-insurance options to employees
  • Health insurance coverage for low-income families (300 percent of the federal poverty level)
  • Health insurance for high-risk individuals (pre-existing conditions)
  • Sale of health insurance across state lines
  • Expansion of Health Savings Accounts, or HSAs
  • Individual membership association health insurance plan
  • Association Health Insurance Plans
  • Medical liability limitations (Tort reform)
As I stated, Herman Cain has a track records of real results in tough situations:  
Unlike Democrat-care, the Republican alternative would not impose fines on workers or employers, require cuts in Medicare, increase taxes, require a new government bureaucracy, require a 'government health insurance' option nor add $1 trillion or more to the national debt.
Herman Cain has been talking to the real people and getting real feedback.  He is currently on hiatus from his radio talk-show host. "The Herman Cain Show," News Talk 750 WSB-Atlanta, airs Monday-Friday, 7 p.m.-10 p.m. EST as he explores a presidential run.  He is a former corporate executive and CEO, and still serves on the board of directors of three corporations that range in size from 4 to 16 billion dollars in annual revenue. His latest book, "They Think You're Stupid," was inspired following his 2004 run for the U.S. Senate as a Republican in Georgia. 

The first political campaign was Ronald Reagan's presidential campaign in 1980.  I remember being almost old enough to vote!   My hands shook as I listened to Mr. Reagan speak to the group of volunteers.  The picture I took of him reflects my shaking hands and big dreams for my country and myself.   

Political issues continue as my passion since the day I saw Mr. Reagan.  Life makes us all wiser, less starry eyed, more realistic.  Life's disappointments make us more skeptical and analytical.  But now is not the time to become jaded in the crucial conservative movement. 

I see in Herman Cain the same intelligence, competence, ability, passion that I saw in Ronald Reagan.  I believe that Cain can (and will) take on health care for United States.  He understands that Obama Care must be dismantled.  It cannot stand.  It must be replaced.  

Mr. Cain understands that there is no need to reinvent the wheel where a good idea already exists. Mr. Cain possesses a unique confidence that doesn't come pre-equipped with an ego requiring that all ideas be his own.  Indeed, Mr. Cain believes that Republicans have already submitted a workable, fine alternative to Obama Care in H.R. 3400.  

God's speed, Mr. Cain.

Sunday, March 13, 2011

Journalist Reports Duke Cancer Research Fraud & Duke Hires for Silence?

Medical research is at the heart of why health care is premier in the United States.  Medical research separates the United States from every other country in the world.  Duke University was once a phenomenal research facility with stellar standards and integrity.  Now, well, not so much.  

Researchers at Duke University routinely add and subtract patients from research studies like disposable ballpoint pens.  One wonders how Duke accounts for the changes in the result findings.  I was once told that the papers my dad signed "must have been signed in error" because "he was never in the study."  Curious.  

The entire "Anil Potti cancer fraud" scandal would be concerning for most reputable medical facilities.  But alas Duke University has another way of dealing with that which others may consider "scandalous."  A great Blog "Duke.Fact.Checker" cites an example and describes how a "problem" is handled.  
✔ Duke University has silenced one of the reporters who dug the deepest into university affairs. 

Fact Checker learned very early Wednesday morning from a concerned Loyal Reader that Sarah Avery has left the Raleigh News and Observer and has been hired at Duke. We confirmed the move with the city desk, but Avery does not yet have a listing at Duke (we checked with the overnight phone operator and on-line directory), and we did not want to wake PR VP Michael Schoenfeld at 2 AM to ask him if she's joining his department or what. 
One of Avery's most recent stories was a poignant portrayal of 63 year old Joyce Shoffner, breast cancer patient (or victim if you prefer) of the quack Dr Anil Potti. FC broke the news about her ordeal in December with exclusive posting of a letter that her brother sent to President Brodhead. At that time, Shoffner declined to speak -- but Avery elicited moving testimony from her that newspapers around the nation picked up because at last we saw a suffering face attached to the story.
Sample quote from the Shoffner article:
"She feels betrayed by Duke, an institution she trusted, and by science, an endeavor she has long championed. 'I'm devastated by this whole thing,' she said. "If you have a very serious cancer and two-and-a-half years later you think you are involved in a study that is cutting edge and [it's discredited], it is devastating."
We got tipped to Avery's move by a Loyal Reader whose daughter had surgery in 2004 at one of the two Duke operated hospitals (but not the main one on West Campus), and went from "a beautiful healthy single mother to someone that lives in pain and the unknown each and every day."
Duke operated on several thousand patients even though surgeons observed their instruments felt "slippery" and "greasy." Yes several thousand. The surgical instruments had been mistakenly washed in used hydraulic fluid from elevators, not sterilizing detergent. The results were devastating in some cases. 
Avery's work exposed the malpractice. But Duke kept the lid on the story by settling with many patients; it wore others out by immorally using its firepower to procrastinate lawsuits. One of the worst legal moves in FC's opinion involves a man who was not hurt: for five years Duke wouldn't tell him if he was exposed to the filthy hydraulic fluid, so he sued. It turned out he was not affected, and now Duke is suing the man to recover its defense lawyer costs. Some days I just seethe at Duke's general counsel Pam Bernard for such tactics.

As a

  • former Duke breast cancer patient, 
  • Duke patient who received implanted metal at Duke in December 2004 that caused my current bone infection and 
  • daughter of dad who died due to Duke's errors, I feel entitled to say . . . 

shame on Sarah Avery.  It appears Ms. Avery was bought off by the very institution (Duke University) that she reported against and purported to protect patients such as Joyce Shoffner from. Shameful.

Thursday, March 3, 2011

Where Can Patients Go For Help? I'm Getting Ready.

I have been a patient, caregiver and private patient advocate.  The one thing that I know for sure is that no matter what the medical provider calls the office (patient resources, patient advocate, ombudsman), a patient can never truly obtain unbiased assistance from a hospital affiliated office that purports to help frustrated patients.

Whatever the medical facility calls the office (ombudsman, patient advocate), the people are there to calm the patient down to prevent litigation.

Most recently, I was sucked in by The Cleveland Clinic's Ombudsman's Office. For example, earlier this week, Ombudsman Becky Streem insulted me.  

Becky Streem seemed to be intimidating me by stating that back in October 2010 orthopedic surgeon George Muschler, MD was uncomfortable treating me based on my mental instability.  

Why?  Because when I was at Cleveland Clinic for a series of outpatient appointments relating to my diagnosis of osteomyelitis, I became very ill after 6 pm.  I vomited repeatedly, knocked my head on the bathroom wall, passed out, was in severe pain.  I asked people in the main lobby of the hospital for help but was ignored.

The Cleveland Clinic Police forced me to spend the night outside on a bench.  It was very cold.  I sick, disoriented and vomited into my knapsack.  The Cleveland Clinic Police taunted me not to fall asleep and accused me of being homeless.  I explained I was a patient of Dr. George Muschler and I was sick.  The Cleveland Clinic Police mocked me.  I spent most of the early morning hours on the telephone with my mom because I was scared of falling asleep.  My mom actually heard the CC Police laughing at me and warning me to not fall asleep.  It was about 3:00 am.  

This week Cleveland Clinic Ombudsman Becky Streem told me that it was my fault that I did not find my way to the CC Emergency Department.  I reminded Becky Streem that I had never been to Cleveland Clinic.  Streem told me that Dr. George Muschler did not trust me to be able to obtain medical care post life saving surgery because I could not find the CC Emergency Department when I was sick in October 2010.  For that reason, Streem explained, Cleveland Clinic Orthopedics refused to treat me.  I was too mentally ill.  Huh?

Becky Streem further told me that both Duke University (Dr. Michael Bolognesi and Dr. Cameron Wolfe) and Cleveland Clinic Orthopedics (Dr. George Muschler and Dr. Michael Joyce) agreed with her assessment of my mental status.  Huh? I have an serious infectious disease (osteomyelitis) and I am too sick to get medical care?

So what can patients do when medical care providers behave unethically?  Cleveland Clinic's Dr. George Muschler diagnoses a serious disease/dead tibia bone and then refuses to treat me?  That seems unethical and just plain wrong.

It is long past time for patients to have a place to go for a real advocate.  Patients need someone who will fight for them to make sure they get the care they deserve.  I am not talking about a lawsuit.  I am talking about proper care before some dies.

My dad should not have died.  Elderly patients shouldn't die in nursing homes.  Families shouldn't have to fight with doctors.  Families should get to spend time with loved ones.  Families should have real respite care.  

I am working with other like minded people to create a system where families can care for patients and loved ones.  And people like myself who are willing to fight the good fight and be the advocates will do just that.  We will make sure the families can be together and enjoy time together instead of being insulted and intimidated by the Becky Streems of the world.

Stay tuned . . . 

Thursday, February 17, 2011

Caregiving: When Does "Until Death Do Us Part" Take Effect?

As caregivers and patient advocates, we often face the issue of a patient who is so ill or incapacitated/suffering from Alzheimer's that physicians insist the patient no longer knows who his or her loved ones are.

Many of us have entered a hospital, hospice or bedroom only to be welcomed with a blank face and a confused "who are you"? We choke back tears and continue on in the role God expects of us - caregiver, friend, family member.

Often the role of spouse continues because of love and loyalty.  Often the role continues to ensure health insurance benefits.

Is there a time when the "healthy" spouse can morally and ethically "abandon" the technical role of spouse and begin a new relationship while the suffering spouse is still alive?

At what point do the marriage vows "until death do us part" take effect and the marriage end?  Obviously, divorce can end the marriage vows but the parties are very much alive.  What about a serious illness? Cancer?  Terminal illness?  Coma?  Alzheimer's?    

At what point can the healthy spouse be free to seek out and have a love affair with another person while still married to a terminally ill spouse? Is it okay so long as all conscious parties are fully informed? Or does having an extra-martial relationship while the spouse is incapacitated reflect a character flaw?

Moreover, what does it say about our society that we would institutionalize our ill and suffering with strangers (where abuse is rampant) so that we can continue with our lives?  We think we deserve something other than caring for those that suffer.  What precisely do we deserve that is more honorable than caring for the suffering among us?

When Doctors Gossiping About Patients Endangers Lives

HIPAA purports to protect patients.  But, as with any piece of legislation, attorneys are often hired to find ways to circumvent that protection.

Doctor A can certainly share confidential patient information with Doctor B to ensure continuity or furtherance of medical care.  Suppose Patient specifically and in writing states that he does not want current treater (Doctor A) to communicate/share medical information with prior treater (Doctor B).  An interesting ethical issue then presents itself when current treater (Doctor A) ignores Patient's directive and communicates with previous treater (Doctor B) in order to "coordinate care."

The ethical dilemma deepens when the conduct of both doctors continues without the knowledge or consent of Patient for over four months while Patient suffers from a life threatening condition.  

(1)  Neither Doctor A nor Doctor B intend to treat Patient

(2)  Neither Doctor A nor Doctor B assisted Patient in locating another qualified physician

(3)  Doctor A caused Patient to incur thousands of dollars in medical bills while at the same time never intending to treat Patient

(4)  Doctor A continued to communicate with Doctor B to "coordinate care" after Patient explained that Doctor B would not be retained to provide any care for Patient 

(5)  Patient spent four months waiting for Doctor A to make a decision about whether Patient was worthy of receiving medical care only to learn that Doctor A preferred Patient return to Doctor B 

Obtaining medical care used to be simple.  A person was sick, went to a physician, (presented an health insurance card) and received medical care.  In extreme circumstances, the health insurance card is not even necessary.  

Today's medical care is more complicated.  Some physicians are, frankly, unexplainable.  There is never, ever a reason to make a sick patient jump through hoops and perform parlor tricks to prove they are worthy of receiving medical care.

If the patient is sick then they should receive medical care.  We don't need Obama Care or The Affordable Care Act to accomplish that.  We need real, human, breathing, ethical physicians.  Those professionals are not as easy to find as one might expect.

Wednesday, February 9, 2011

Can You Trust Nursing Homes?

Gangrene and Osteomyelitis Cited in Wrongful Death Lawsuit Against Nursing Home   

The author of the above article and The Nursing Home Abuse Blog is Jonathan Rosenfeld.  He is an attorney.  But, more importantly, he is a solid person who is on the front line of protecting people in nursing homes.  His Blog is very instructive and should be required reading for caregivers.

We have talked about the topic of neglect and bedsores on this blog.  We have discussed how a horrifically neglected bedsore is a wound that (when ignored by medical personnel) can progress down to the bone and infect and kill that bone.  That is osteomyelitis. The infection can enter the bloodstream, the patient can become septic and die.  And that doesn't even begin to discuss the gangrene.

What are we allowing to happen to our vulnerable and elderly?

I understand the topic of nursing home care is very sensitive and personal.  The decision to place a loved one in a nursing home is not a decision that any family member or friend makes lightly or without thoughtful consideration.  That being said, nursing home placement is not an optimal living arrangement.  Hopefully, the placement can be as short as possible and a diligent family member or friend can be present as many hours as possible.

During one of my dad's first hospitalizations at Duke University Hospital, the hospitalist physician and nurses were anxious to have dad placed in a nursing home.  The attending hospitalist was so insensitive and told me "you have a life too."  

Dad was 4 months status post a completely successful colon cancer resection with very wide clean margins.  Dad was just suffering with a difficult urinary tract infection.  That was it. 

I asked dad's clinic urologist (also from Duke) whether dad should be in a nursing home.  I wanted whatever was best for dad.  

The urologist first reminded me that in elderly men often the only presenting symptom of a urinary tract infection is altered mental state (confusion).

The urologist (who knew dad better than the hospitalist) told me that if dad went to a nursing home:

  • The nursing home staff would be a catheter in dad (because it is easier for the staff);
  • Dad's urinary tract infection would continue until it ultimately reached his kidney and that would be the beginning of the end for him;
  • I would absolutely need to spend as much time in the nursing home monitoring dad's care as I did in the hospital because dad would receive less care/attention in the nursing home;
  • I would need to make sure dad moved every day so that he did not get bedsores or abused.

I chose to take care of my dad at home.  It wasn't easy.  But the alternative of risking a nursing home placement was not worth it.  

Sunday, February 6, 2011

Preventing Caregivers From Suffering Poor Health

Last week the Gallup Poll reported that Caregivers Suffer from Poorer Physical Health.  According to the article, 
Americans who work a full-time job and say they care for an elderly or disabled family member, relative, or friend, suffer from poorer physical health than those who work a full-time job but do not have additional care-giving responsibilities.
The implications from the medical community are obvious and the recommendations are equally obvious.  Maybe its part of the big plan of rationed care.  The Study certainly does not encourage families to care for one another.  rather, the Study suggests that it would be wise to: 

(1) get non relative home health care; or 

(2) get the elderly relative out of the house.

But in America, we take care of our own families whenever possible. We sacrifice for our loved ones to be together.  It's the American way.  That was my family.

So what causes the caregiver's health to fail?  

Why is care-giving so stressful?  

(1) Caregiver already sick or injured

Caregivers who are already sick or injured when the family member becomes seriously ill learn quickly to "suck it up" and do what needs to be done.  But the body can only withstand stand so much.

In my family, wheelchair transfers and physically helping my dad were exceptionally tough for me because (a) my left leg was in pain and (b) I was still undergoing cancer treatments.  

My weakened leg often caused me to fall down after I transferred dad safely.  Of course, I explained the problem with my leg to my Duke Orthopedic surgeon and explained how the hardware in my left leg hurt.  But my complaints were dismissed.

(2) Patient's documented symptoms ignored  by physicians

In order to provide the best care possible for their patients, physicians should work with the family caregivers.  

Caregivers are the ones that understand the patient's pain, appetite level, mood, urine and bowel output.  We take vitals 3-4 times a day.  We know what medication side-effects the patient experiences.

My dad was probably no different than other elderly patients that have complications from cancer chemotherapy.  My dad had bone injuries and terrible skin infections.  

Dad was in horrific pain and cried out in pain during the night.  Although I
requested dad's physicians address my dad's issues of pain, the physicians were concerned that my dad would get addicted.  The pain caused dad to lose multiple nights of sleep and consequently I lost sleep too.

At appointments, I told the nurses and physicians about dad's symptoms. When the nurses or physician asked my dad how he felt or whether he had a symptom that I described, my dad denied the symptom.  Dad would insist he was fine.  

Dad came from a generation and a family where men did not complain. Since my dad did not have dementia, the physicians chose to accept dad's word.  The doctors would ignore me, the caregiver.  That was wrong for the physicians to do.  

Dad's physicians should have had the sense to know that dad wanted to be a good patient, he did not want to complain.  The physicians should have listened to me, the caregiver.  The physicians should listen to every caregiver irrespective of whether the patient suffers from dementia.

Dad and I repeatedly left the physician's office.  We returned home and dad continued to suffer.  I continued to struggle to care for him without any cooperation from the physician.

The medical professionals must communicate, cooperate and work as team with the family caregivers.  In my dad's case, that did not happen.  Ironically dad's orthopedic surgeon was my orthopedic surgeon and knew that I was struggling to walk and move with my left leg.  As such, the orthopedic surgeon knew or reasonably should have known that his refusal to work with me as a team with respect to my dad's care would harm both dad and me.

Dad's health continued to deteriorate and so did mine.  But in my case, the deterioration of the caregiver's (me) health was avoidable.  Physicians saw dad and myself every week.  Physicians knew I was the caregiver and that I was injured and suffering.  

Even if the caregiver does not come to the "game" injured, the physician must respect the caregiver's work. If the physician does not respect the caregiver's work then, inevitably, the caregiver well-being and health will suffer.  In turn, the care to the patient will suffer.

What caregivers can do

I was actually injured (painful metal in my leg and completing cancer treatment) when I started care-giving.  

As a caregiver, you may be starting with a relatively healthy slate so to speak.  That does not mean that you are immune from wear and tear.  

(1)  Get a check up with a good physician that focuses on total well being.  This physician may not be your regular primary care physician (pcp).  

For example, at this point, I am both the patient and caregiver.  I am getting sicker with my bad leg and still have no physician to care for me.  I am proactive with my basic health as I wait for a surgeon to help me. I wish I had seen a caring doctor that focuses on the whole body when I was ignored by my regular pcp.

The physician I see now focuses on health, foods I eat, B-12 vitamin injections, compounded natural substances and reduces inflammation and weight.  He keeps track of my heart EKG and blood work.  I feel stronger and healthier now than I have in months - and that is with a painful, oozing leg.  I feel some control over my health.  

Caregivers would benefit from this type of medical intervention.  I had a psychiatrist and traditional physicians.  But the pain from the ignored orthopedic condition wore my body out.  I needed more than pharmaceuticals.

(2)  Caregivers must be insistent with the patient's physicians that there be a team approach to the care.  That team must include the caregiver.  

a.  Ask the physician what vitals or symptoms he wants you to track.  If the physician wants you to track pain, ask whether he wants you track on 1-10 scale.

b.  Get a notebook and be diligent about keeping track of the information. Be sure to include dates and times of information. 

c.  Before each appointment, write down a list of questions for the physician.

d.  Share the information and ask questions with the physician at each appointment.  

e.  Ask for the physician's input and plan based on the symptoms.  Use a different color ink to write the physician's plan.  If the physician chooses to do nothing regarding a symptom (eg. pain) then be sure and write that fact down.  Ask the physician why and write the reason down.  

f.  Take notes of what the physician says in addition to his decision regarding symptoms.
g.   Date the notes from the appointment. 

h.  Get copies of all blood work and test result.  Keep them all together by date.

The more organized you are as the caregiver, the less stressed you will be and the healthier you will be.

Friday, February 4, 2011

Top Ten Most Wanted for Health Care Fraud

As an advocate and caregiver, you must be on the watch for insurance, Medicare and healthcare fraud.  

Advocates and caregivers should examine and organize every medical bill, insurance statement and Medicare EOB.  

In my experience, the most common place where fraud is committed is in the area of Durable Medical Equipment (DME).  This includes everything from rented walkers and portable toilets (yes, you rent those things) to oxygen.

The most egregious example for me was a Request for Equipment that was contained the signature of a Duke University Medical physician and accompanying Medicare EOB indicating that Apria DME supplier was reimbursed by the US Federal Government for very expensive equipment that my dad never received.  

Although I reported the error, years later when my dad needed the equipment, the claim was disallowed because the fraudulent claim still appeared on the Medicare records.

The United States Department of Health and Human Services, Office of Inspector General is entrusted with the duty to prevent, investigate and prosecute Health Care Fraud.

As of the date of this posting, the current "Top Ten" are listed below.  
In all, the OIG is seeking more than 170 fugitives on charges related to health care fraud and abuse.

Carlos Benitez
Jose Benitez
Caridad Gullarte
Clara Gullarte
Leonard Nwafor
Luis Benitez
Dr. Steven Moos (captured)
Reynel Betancourt (captured)
Susan Bendigo
Eduardo Moreno

OIG Fugitives: “The Benitez Brothers”: Carlos Benitez, Luis Benitez, Jose Benitez

  • Carlos, Luis, and Jose Benitez, commonly referred to as the "Benitez Brothers," allegedly schemed to submit false and fraudulent claims to Medicare, pocketing approximately $110 million from Medicare, according to a Federal indictment.
  • The Benitez brothers owned and directed a string of medical clinics in the Miami area, purportedly providing infusion treatments to HIV-infected Medicare beneficiaries. But the medication the brothers provided to patients either was allegedly medically unnecessary or was never actually administered.
  • The brothers allegedly paid kickbacks to patients in exchange for the patients’ Medicare information, which they then used to submit false claims to the Federal Government for reimbursement.
  • More than 20 co-conspirators of the Benitez brothers have been charged in the Southern District of Florida with involvement in the HIV-infusion conspiracy. Most of them have pleaded guilty or have been convicted by a jury. A physician involved in the conspiracy was sentenced to a record-setting 30 years in prison.
OIG Fugitive: Dr. Steven Moos
  • Dr. Steven Moos is charged with drug possession, fraudulent Internet marketing, and child endangerment.
  • Formerly a general practice physician in Oregon, Moos lost his medical license after he repeatedly prescribed numerous prescription drugs over the Internet, despite warnings from the State medical authorities to stop such practices.
  • According to the Oregon Board of Medical Examiners, Moos prescribed drugs and refilled prescriptions without physically examining patients or obtaining health record information from them or their primary care providers.
  • After his medical license was revoked, Moos allegedly continued to practice medicine and prescribe drugs and made false statements on a Drug Enforcement Administration registration renewal application to conceal the fact that he no longer had a medical license to prescribe drugs, according to the indictment.
  • The Federal indictment stated that in the summer of 2002, Moos allegedly ordered misbranded drugs (including human growth hormone) from China. The drugs did not have adequate directions for use or warnings and other required information.
  • In February 2010, Moos was arrested and found guilty in the United Arab Emirates (UAE) of impersonating a physician and performing surgery in his villa. Sentenced to 2 months in prison, he also faces other charges in another part of UAE. U.S. authorities are working with UAE officials to bring Moos back for trial in the United States.

OIG Fugitives:Clara Guilarte, Caridad Guilarte, and Reynel Betancourt (CAPTURED)

  • Clara and Caridad Guilarte and Reynel Betancourt allegedly defrauded Medicare of nearly $4.3 million (and submitted $9.1 million in false and fraudulent claims), according to a Federal indictment. On November 30, 2010, authorities captured Betancourt in the Dominican Republic and subsequently sent him to the United States; the Guilarte sisters are still at large.
  • OIG is tracking down the Guilarte sisters in connection with the operation of the Dearborn Medical and Rehabilitation Center (DMRC) an infusion therapy clinic in Michigan. OIG alleges that the Guilarte sisters set up and operated the clinic where Betancourt was an employee.
  • All three fugitives allegedly committed health care fraud, conspiracy, and money laundering. The trio allegedly recruited and paid cash and other inducements to Medicare beneficiaries to visit DMRC and sign forms indicating that they received legitimate medical services, including injections and infusions of expensive medications, although the services allegedly were never provided.
  • All three are originally from Cuba: Clara Guilarte is a U.S. citizen, and both Caridad Guilarte and Betancourt are permanent U.S. residents.
OIG Fugitive: Susan Bendigo
  • Along with her co-conspirators, Susan Bendigo, who was born in the Philippines, is accused in a Federal indictment of billing Medi‑Cal, California's Medicaid program, for $17.1 million, collecting $10 million, about half of which came from the claims she submitted for services she provided with unlicensed staff.
  • A registered nurse, Bendigo was director of nursing for a company that provided nurses for home health agencies. Investigators say that from May 2004 through May 2007, she sent unlicensed nurses to treat patients under Medi‑Cal, even though she knew that Medi‑Cal required licensed nurses to perform the work.
OIG Fugitive: Leonard Nwafor
  • Through his durable medical equipment (DME) company, Pacific City Medical Equipment, Nwafor and his co-conspirators billed Medicare for $1.1 million and collected $525,000 in fraudulent claims for equipment such as motorized wheelchairs, scooters, and hospital beds for beneficiaries, according to a Federal indictment.
  • Based in the Los Angeles area, Nwafor used physicians’ Unique Provider Identification Numbers to bill Medicare for the equipment, even though those doctors did not examine Nwafor’s clients.
  • OIG investigated Nwafor
  • In the fall of 2008, a jury convicted Nwafor of conspiracy and health care fraud. He was to be sentenced in January 2009, but failed to show up in court. In March 2010, he was sentenced in absentia to 9 years in Federal prison and ordered to pay back more than $525,000 to Medicare.
OIG Fugitive: Eduardo Moreno
  • According to an April 2007 Federal indictment, Eduardo Moreno allegedly stole hundreds of thousands of dollars from the Medicare program, submitting false and fraudulent claims for durable medical equipment (DME) “and related health care benefits, items and services” that were medically unnecessary.
  • Moreno used a “straw owner” and other methods to hide the money and property he obtained through these fraudulent schemes, the indictment alleged. (A straw owner is an individual who maintains the appearance of owning property in order to disguise the identity of the real owner.)
  • He was arrested by the Miami Police Department on an open warrant. He failed to appear in court and his current whereabouts are unknown.
Be proactive - watch out for your own elderly and those for whom you care.  In addition, I recommend that you watch out for your neighbors.  I have known my elderly next door neighbors since I was 4 years old.  

Today both husband and wife are disabled (stroke victim and Alzheimer's) and are living in their own home.  Periodically, I make contact with their home health workers and re-introduce myself, ask if there is anything I can do and thank the ladies for their kindness.  

I am keenly aware that there are beautiful, kind people in this world.  However, I am not so naive to think that, in these desperate times,  the elderly and disabled cannot be victimized. Neighbors and friends must not presume the elderly are safe simply because a home health worker drops by everyday.

Advocates Must Stop Hospital Staff From Abusing Elderly

As an advocate/care-giver/adult daughter of a dad, I watched many events take place in hospitals, clinics, Emergency Departments (Duke University in Durham and Raleigh North Carolina)

As with all hospital stays, some procedures and events were positive and some were negative.  But sometimes, I actually needed to intervene because hospital and medical staff were abusive to my dad.  This is precisely why family members cannot just leave the elderly at the hospital and expect total strangers (albeit medical care professionals) to have your loved ones best interests at heart.

As a care-giver and advocate, you may find yourself in the position of witnessing abuse on your loved one.  There isn't time to make a phone call or have a discussion.  You must just intervene and speak up immediately.

Below are two of my personal examples:


My dad was in the hospital and the physician ordered a foley catheter.  Two very young nursing assistants (20 somethings) were assigned with the task.  I left the room to give dad some privacy.  But I did not go too far.

As I leaned outside the door, I heard the two young ladies alternating between giggling and yelling at my dad to remain still while they were jamming a cath up his penis.  

And then a heard a slap sound.  And then I heard my dad's frightened, quivering voice begging "don't hit me."

My response - I immediately opened the door and told the ladies to stop whatever they were doing.  Before I get further than "stop that is enough," one of the ladies yelled out "we need restraints."  

I told the nurses "no restraints, no catheter."  As they left the room, one nurse informed me "the cath is already in."

I looked at my dad and he was shaking and in tears. I held dad in my arms until he stopped shaking.  

I was in shock at the nurses' behavior and could not immediately process why the nurses would have be requesting restraints ... unless they wanted to punish my dad for some unknown reason.

If you ever hear a nurse yelling (much less hitting) your loved one or if you hear your loved one frightened then you must intervene and stop the behavior.


I was in the hospital with my dad when he was post operative and in need of 24 hour observation.  I was the "observer" as many hours as possible.  But for the few hours that I drove to my mom's home and helped her out with meals and caring for the animals, the hospital placed on of their employees.

One evening, I arrived back to spend the night in dad's hospital room.  When I arrived in dad's room, I was horrified to see that the hospital employee (called a "sitter") had turned all the lights on and was chatting with a friend on her cell phone.  She had the television on loudly.  There was zero consideration for my dad.

I said "hello" to my dad and smiled at me.  Then I turned down the television.  I politely told the "sitter" that she could leave now.  She said that she was told to stay with him all night.  I told her that was unnecessary.  

My dad thanked her for keeping him company.  Then, the "sitter" asked my dad (with almost an evil grin on her face) "do you remember me"?  My dad said "sure."  Then, the "sitter" asked (as if to taunt my dad)  "okay, then what's my name"?  Before I could answer for my dad, there was a knock on the door and another hospital employee entered my dad's hospital room to deliver the "sitter" the Dominos Pizza she ordered for herself.

My response - I excused myself from the room and went to the nurses desk.  I asked to speak with the charge nurse.  I explained to the charge nurse what had transpired and then stated that I did not want that "sitter" in the room with my dad ever again. Period.  

There are many more examples of times when I intervened at Duke University Medical (both in Durham and Raleigh) to protect my dad.  I will share more later.

All advocates and care-givers should protect the elderly from abuse - even if the abusers are medical care providers.